Friday, April 24, 2009

When the Patient Gets Lost in Translation

The above is the title for an article appearing in the NY Times today. The piece discusses the difficulties American doctors have dealing with patients who don't speak English.

But how about the other way around?

Three years ago I went to the big clinic up north for an annual checkup and a stem cell harvest. Now I want to emphasize that with one exception the care I've had there has been superior in every way. The place is so fantastically laid out and organized that we spent part of the time just walking around the campus enjoying the architecture.

The first two days we were there I had approximately a dozen tests. The results would show the status of my multiple myeloma. Though it is incurable there are several drugs that can extend life. I dion't remember now exactly what the problem was but a few of the tests I'd had in Cedar Rapids indicated that the folks up north needed to evaluate my neck. The kind of pain I was having felt very much like the pain I had when the cancer first appeared next to my spine.

At the conclusion of the tests we were given the name of the doctor who would go over the conclusions with us. We were both nervous obviously.

I was never sure what nationality the man was. He was likely in his fifties, good suit, eyeglasses, expensive shoes. He spoke slowly in English but his accent was thick enough that I couldn't understand some of the words. No sweat. The report could be summarized in a sentence. There was cancer on my neck or there was not cancer on my neck. Every doctor we'd dealt with up there had been been friendly but concise.

The conference began when I asked this doctor what the verdict was. And when he told us how he wanted to proceed Carol and I looked at each other wondering what the hell he was talking about. He would not simply give us the answer, he said. He wanted to read the report. He held the report up. It appeared to be four or five single spaced pages.

I tried to be polite. I told him that a) we'd never be able to understand the medicalese (I'd seen many such reports by then) and b) and I was very apologetic) I was having a difficult time understanding him when he spoke. Which was sure as hell true.

But he insisted. He began to read. Carol and I kept glancing at each other. To us it was gibberish. He got about half a page out when I said, "Just tell me if the cancer is on my neck."

He got mad. "This is how I make my reports." From the on he willed me out of existence. He refused to answer my questions; and he refused to make any kind of eye contact with me.

He addressed everything to Carol. I don't remember exactly how Carol cut him off but somehow she did. We'd been in there twenty minutes or so by now. And we just left. With no answer.

We were stunned. We stood in the hall as all these busy doctors and nurses and patients flowed around us. And somewhere among them was this big red-headed Irish doctor who obviously read the anger and confusion on our faces. He asked if we were all right. We both started telling him what had happened. He said the other doctor's name and kind of smiled. Then he said "C'mon into my office."

He walked over to his desk, leaned over--he was probably six two or six three--and said, "I need your full name and your social security number."

I gave it to him. He started punching keys. He spent no longer than a minute reading. Then he looked at us and smiled and said, "Oh, hell, you're fine."

Have you read the short story "Interpreter of Maladies" by Jhumpa Lahiri? It's all about a man who works in a doctor's office translating patient complaints from one language or dialect to one the doctor can understand.

Ah, the joys of medicine... more than twenty years later, after my own cancer surgery, I had leakage from a small incision on my back that was used to drain the main incision.

So one of the surgeons -- and this was at Dartmouth-Hitchcock, not some obscure out-of-the-way hospital -- decided the small incision needed to be stitched up. And instead of spending an extra 10 or 15 minutes to give me shot of Novocain, he told me, "Nah, it'll be quicker if I just put in two stitches..."

Well.

I'm told they could hear my yelling clear on the other side of the ward.. and Mom & Dad, horrified at what happened, saw my toes curl up...

But I guess I shouldn't complain... after all, I'm still here *to* complain...